Family Needs to Know When Patient Survival Is Uncertain

MONDAY Dec. 29, 2008 -- The vast majority of families of critically ill patients want doctors to frankly discuss the patient's prognosis even if it is uncertain, a new study finds.

The University of San Francisco Medical Center study, published in the second January issue of the American Journal of Respiratory and Critical Care Medicine, points out a definite rift in this area. Past research has shown that doctors hesitate to talk about uncertain prognoses with patients' families.

Interviews with 179 "surrogate decision-makers" for patients in intensive care units revealed that 87 percent wanted to know all prognostic estimates, even if the estimates were tentative. Most viewed a physician being candid about uncertain outcomes as honest rather than a source of confusion or anxiety.

"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process," lead author Dr. Douglas White, an assistant professor in UCSF's division of pulmonary and critical care medicine, said in an American Thoracic Society news release. "I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."

But he also cautioned against a "one-size-fits-all" approach, since 12 percent of those interviewed said they did not want to discuss uncertain prognoses.

"Our findings suggest that physicians need to develop the skills to understand the unique needs of surrogates, and then tailor their approach to discussing prognosis to meet those needs," he said. "This is an area in need of well-designed quantitative and qualitative studies."

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